Provider Demographics
NPI:1982154720
Name:MATHENEY, KELSEY BRIANA (CNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BRIANA
Last Name:MATHENEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2546
Mailing Address - Country:US
Mailing Address - Phone:870-212-0398
Mailing Address - Fax:
Practice Address - Street 1:201 E OAK AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4163
Practice Address - Country:US
Practice Address - Phone:870-935-6729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner